Noncommunicable diseases (NCDs) are the leading cause of death globally. On its road to ensuring universal health coverage (UHC) for its population, India initiated the Ayushman Bharat mission in 2018. Under this flagship initiative, the primary health care component is being implemented by establishing Health and Wellness Centers (HWCs) across the country. HWCs are being established by converting and upgrading the primary health centers and subhealth centers. The unmet need for NCDs at the primary care level is high. Under the HWCs, NCD services are being expanded at the community and facility levels. States have brought local innovations in the NCD management. NCD ticker bags, an innovation to ensure treatment adherence, follow-up, and reduce drop-outs, are being done under the HWCs. Gaps in NCD management include a lack of awareness about NCDs' risk factors and management in rural areas and an erratic supply of NCD drugs and diagnostics. Challenges in the NCD management in the primary care settings include capacity building of the health manpower in NCD management, the flow of information for ensuring a continuum of care, and low community participation in the screening and management of NCDs. The challenges that remain in operationalizing the envisaged package in the HWCs must be acknowledged and worked upon. This will enable us to continue on the path toward UHC, stick to the action plan on NCDs, and assist us in achieving the NCD-related targets.

Background: National tobacco-free school guidelines were introduced in India in 2009. We assessed compliance with these guidelines across both government, government-aided, and private schools in Udupi district of Karnataka state in India. Methods: We visited 915 upper primary and high schools across Udupi district and used a standardized checklist for visual inspection of the school environment and interviews with a school representative to ascertain compliance with guidelines (display of a tobacco-free school/institution board, presence of no smoking signage, no tobacco sale within 100 yards, presence of a Tobacco Control Committee, integration of tobacco control activities into the school health program, and availability of a copy of Cigarettes and Other Tobacco Products Act). Results: A tobacco-free school board was displayed at the main entrance of 73% of schools, and there was no evidence of tobacco products on sale within 100 yards of 96% of schools. However, only 5% of the schools reported having the Committee; 4% reported having a copy of the Cigarettes and Other Tobacco Products Act, 2003 with the school, and no smoking signage was observed in < 1%. Integration of tobacco control activities into the school health program was reported in 91% of schools. Conclusions: Compliance with tobacco-free school guidelines in Udupi was far from complete, indicating the need for enhanced implementation and monitoring.

Background: Association between low-dose aspirin (LDA) and possible covert effects on hemoglobin (without overt bleeding) has been inconsistent. The current study was planned to assess the effects of LDA on hemoglobin level and serum iron status over a period of 6 months in nonanemic patients with acute coronary syndrome (ACS) or ischemic stroke. Methods: This was a hospital-based open cohort prospective study conducted on newly diagnosed patients with ACS or ischemic stroke discharged on secondary prophylaxis of LDA (<162 mg/day) The study period was 6 months of patient recruitment and 6 months of follow-up. Results: Out of originally recruited 81 patients, 52 were followed up for the entire 6 months. The mean age was 61.8 ± 8 years. In 43 (82.6%) patients, the hemoglobin level had a fall at 6 months from the baseline level. Male patients had a significant fall in hemoglobin levels while as females had an insignificant change. Anemia was detected in 20 (38%) cases at the end of 6 months. The incidence of anemia was 0.38 cases/180 days. A fall in serum ferritin was observed in 30 patients and a rise was observed in 22 patients. At the end of 6 months, serum ferritin fell to <20 μg/L in five patients, out of which two patients had serum ferritin <15 μg/L. Conclusion: The study provided insight about the effect of LDA on the hemoglobin level and serum iron profile among the patients who were started on LDA for the secondary prophylaxis.

Introduction: By 2030, the noncommunicable diseases (NCDs) are expected to overtake communicable, maternal, neonatal, and nutritional diseases combined as the leading cause of mortality in sub-Saharan Africa. With the increasing trend in NCDs, the NCD risk factors (NCDRF) need to be understood at local level to guide NCD risk mitigation efforts. Therefore, we provide a detailed analysis of some modifiable NCDRF and their determinants in Malawi using the 2017 Stepwise survey (STEPS). Methods: This is a secondary analysis of the Malawi 2017 STEPS. Data were analyzed using frequencies, proportions, odds ratios, and their associated 95% confidence intervals (95%CI). We fitted multiple logistic regression of the NCDRF on the explanatory variables using the likelihood ratio test. The level of statistical significance was set at P < 0.05. Results: Of the 4187 persons, 9% were current smokers, 1% were taking alcohol, 16% had a high salt intake, 64% had insufficient fruit intake, 21% had low physical activity, 25% had high blood sugar, and 11% had high blood pressure. Smoking odds increased with age but decreased with the level of education. Females had lower odds of engaging in harmful alcohol use than males (adjusted odds ratio [AOR] = 0.04, 95%CI: 0.01–0.17, P < 0.001). Females had lower odds of high salt uptake than the males (AOR = 0.70, 95%CI: 0.58–0.84, P = 0.0001). Persons in nonpaid jobs had higher odds of salt uptake than those employed (AOR = 1.70, 95%CI: 1.03–2.79, P = 0.04). Females were 22% more likely to have insufficient fruit uptake compared to males (AOR = 1.22, 95%CI: 1.06–1.41, P = 0.007). Conclusion: The high prevalence of physical inactivity, high salt consumption, insufficient fruit intake, raised blood glucose and high relative blood pressure calls for a sound public health approach. The Malawi Ministry of Health should devise multisectoral approaches that minimize exposure to modifiable NCDRF at population and individual levels.

Introduction: Altered glycemic status in people with or without chronic diseases is likely to be associated with a higher risk of cardiovascular diseases and increased risk of morbidity and mortality in African adults. Although physical activity interventions are imminent public health measures in regulating glucose control and resulting diabetes risk, the summary of evidence to inform public health experts about advocating the physical activity interventions in low-middle income countries in Africa is lacking. Objective: The objective of this study was to provide a summary of evidence regarding the effects of physical activity interventions on glycemic control in African adults with and without chronic diseases. Methodology: Six electronic databases (Scopus, Web of Science, CINAHL, Embase, Ovid, and PubMed) will be utilized for synthesizing evidence from randomized controlled studies investigating the effects of physical activity interventions on blood glucose levels in African adults. The data (time, duration, and frequency of physical activity interventions, wash-out period, mean differences, and standard deviations of outcomes such as glucose, insulin, and glycosylated hemoglobin within and between groups) will be extracted from the included studies. The quality of the included studies will be assessed by the Cochrane Risk of Bias tool and GRADE criteria. Clinical Relevance: To the best of our knowledge, this will be the first systematic review to appraise the empirical evidence that would investigate the effectiveness of physical activity interventions on glycemic control in African adults. The evidence is proposed to serve as a guide for public health experts to design effective physical activity interventions aimed at achieving optimum glycemic control among African adults. Results and conclusion: The systematic review will collate empirical evidence exploring the effectiveness of physical activity intervention on glycaemic control in African adults. The findings may inform the stakeholders and policymakers in designing and implementing physical activity interventions for appropriate glucose control in African adults.

Introduction: India is the largest democratic nation in the world, where 68.84% of population resides in the rural areas. There are many flagship programs for the rural development in India: National Rural Health Mission, The National Rural Livelihood Mission, Sansad Adarsh Gram Yojna Gram Swaraj Abhiyan. A full-fledged comprehensive rural development model based on healthy setting concept is not existing as per the literature review in our country. Objectives: This cluster randomized control trial will evaluate the effectiveness of health promoting village model on health outcome of residents of villages of Boothgarh, Punjab. Methods: The health promoting village model will be based on the principles of multisectoral participation, use of technology, capacity building, and community empowerment with following components: Personal, social, human, and economic development. Model will be delivered through health brigade by training sessions, nukkad nataks, demonstrations, and awareness campaigns. The control group will receive the usual care by the health center. Results: The primary outcome of the study will be change in intake of fruits, vegetables and fat, metabolic equivalent minutes per week, change in personal hygiene practices, change in literacy, reproductive and child health, family planning practices, change in Nirmal gram score, Villagez Swacchta Index, skill-based jobs and enrolment under social security. Baseline and endline (1 year after intervention) assessments will be done using the standardized tools. Cost of the implemented model will also be identified. Conclusion: Effectiveness of the health promoting village model will be identified after 1 year of implementation.